AB0278 IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING bDMARDs, THE CHARLSON COMORBIDITY INDEX IS MORE PRONOUNCED THAN PSORIATIC ARTHRITIS
Authors: G. Sandal Uzun, O. D. Tatar, N. E. Gezerer, E. Bilgin, G. K. Yardimci, E. C. Bolek, B. Farisogullari, E. Duran, Z. Özsoy, G. Ayan, M. Ekici, E. Unaldi, L. Kiliç, U. Kalyoncu, O. Karadag, A. Akdoğan, Ş. A. Bilgen, S. Kiraz, A. İ. Ertenli
Journal: Annals of the Rheumatic Diseases (2022)

Background According to international recommendations, co-morbidities must be taken into account in the management of patients with inflammatory arthritis. Objectives To evaluate the distribution of pre-treatment comorbidities in the bDMARD cohort including patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Methods The Hacettepe University biological database (HUR-BIO) was established in 2005, 581(75.4% female) patients with RA and 520 (69.4%female) patients with PsA enrolled up to 2021 were analyzed. Diagnosis of RA and PsA were based on the clinical evaluation of the rheumatologist who followed the patients. Comorbidities of the patients were reviewed retrospectively from the biological database, hospital electronic records, ICD-10 diagnostic codes and prescriptions of patients. Diabetes mellitus (DM), Hypertension (HT), Dyslipidemia (DL), Coronary artery disease (CAD), Body mass index (BMI) and smoking were recorded. DL was grouped in terms of lipid values ​​according to the classification of the Turkish Society of Endocrinology and Metabolism Dyslipidemia Guide(1). Detection of coronary artery disease before the age of 55 in men and of 65 in women was classified as premature - CAD. Data on Chronic Kidney Disease, obstructive pulmonary disease, Cerebro-vascular disease, Thyroid Diseases were also recorded. The Charlson comorbidity index (CCI) was calculated by summing the comorbidities in the patients’ medical history before the bDMARDs. Results The distribution of comorbidities in patients with RA and PsA prior to initiation of bDMARDs was given in Table 1. Patients with RA were older and smoking was more common. HT(28.5% for RA, 21.9% for PsA) and thyroid diseases (22.7% for RA, 14.7% for PsA) were the most comorbidities in both groups. Compared to PsA, patients with RA had higher rate of comorbidities (64.8% vs. 40.4%, p&lt;0.001). Multimorbidity was detected in 231/581 (39.7%) of patients with RA, and it is significantly more common than the patients with PsA (21.8%) (p&lt;0.001). There was no difference between the groups in terms of cardiovascular comorbidities such as BMI, DM, and dyslipidemia. When adjusted for age, the comorbidity burden according to CCI was 3.96 (2.57-6.13, p&lt;0.001) times higher in patients with RA than in patients with PsA. Table 1. Comorbidities in RA and PsA patients Features RA n=581 PsA n=520 p Gender, female n (%) 438 (75.4) 361 (69.4) 0.027 Age at PsA diagnosis, mean (SD) years 46.7 (13.7) 39.3 (12.0) &lt;0.001 Age at bDMARD start, mean (SD) years 49.5 (13.8) 42.2 (12.3) &lt;0.001 CCI -No comorbidity 205/581 (35.2) 290/486 (59.6) &lt;0.001 -1 comorbidity 145/581 (24.9) 90/486 (18.5) -≥ 2 comorbidity 231/581 (39.7) 106/486 (21.8) CCI mean, (SD) 1.56 (1.77) 0.78 (1.18) &lt;0.001 Smoking (ever), n 292/581 282/506 &lt;0.001 BMI, mean (SD) 29.3 (6.7) 29.6 (5.9) 0.50 BMI ≥ 30 n 261/577 221/498 0.77 Diabetes Mellitus, n 68/581 49/402 0.30 Hypertension, n 166/581 110/502 0.012 Dyslipidemia* n -High TC 47/270 32/161 0.30 -High TG 62/242 45/159 0.79 -High LDL -C 53/289( 43/175 0.38 -Low HDL-C 88/267 57/157 0.48 Uric acid (&gt;6 mg/dl), n 150/554 136/437 0.16 CAD n 59/524 32/486 0.010 Premature CAD, n 39/581 18/486 0.030 CKD, n G1 (GFR &gt; 90) 437/523 0 &lt;0.001 G2 (GFR 60-90) 68/523 0 G3a (GFR 45-60) 11/523 0 G3b (GFR 30-45) 5/523 28/370 G4 (GFR 15-30) 2/523 342/370 Lung disease, n -COPD 15/519 3/485 0.007 -Asthma 66/520 19/485 &lt;0.001 Thyroid disease, n 132/581 65/440 &lt;0.001 *TC &gt; 240, TG 150-499, LDL-C&gt; 160, HDL-C erkek &lt; 40, kadin &lt; 50 CCI: Charlson comorbidity index, CAD: Coronary artery disease, CKD: Chronic Kidney Disease, COPD: Chronic Obstructive pulmonary disease Conclusion The burden of comorbidities in patients with RA before bDMARDs is more pronounced than in patients with PsA. Although, cardiovascular risk factors were similar, with the exception of hypertension and smoking, the age-adjusted CCI was 3.96 times higher in patients with RA than in patients with PsA. References [1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9 th ed. 2021 Disclosure of Interests None declared